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General NPI Number Information
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NPI Number | 1023571650
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Entity Type | Organization
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Legal Business Name | VIRGINIA IPAPO-AGUSTIN DDS INC
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Dates
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Enumeration Date | 04/10/2019
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 525 N AZUSA AVE STE 112
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City | LA PUENTE
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State | CA
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Zip | 91744-4261
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Country | US
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Telephone | 626-336-4453
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Fax |
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Provider Business Mailing Address
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Address Line | 525 N AZUSA AVE STE 112
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City | LA PUENTE
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State | CA
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Zip | 91744-4261
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Country | US
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Telephone | 626-336-4453
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VIRGINIA IPAPO AGUSTIN
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Credential |
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Telephone | 626-336-4453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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